Poor oral health linked to higher blood pressure, worse blood pressure control

People with high blood pressure taking medication for their condition are more likely to benefit from the therapy if they have good oral health, according to new research in the American Heart Association’s journal Hypertension.

Findings of the analysis, based on a review of medical and dental exam records of more than 3,600 people with high blood pressure, reveal that those with healthier gums have lower blood pressure and responded better to blood pressure-lowering medications, compared with individuals who have gum disease, a condition known as periodontitis. Specifically, people with periodontal disease were 20 percent less likely to reach healthy blood pressure ranges, compared with patients in good oral health.

Considering the findings, the researchers say patients with periodontal disease may warrant closer blood pressure monitoring, while those diagnosed with hypertension, or persistently elevated blood pressure, might benefit from a referral to a dentist.

“Physicians should pay close attention to patients’ oral health, particularly those receiving treatment for hypertension, and urge those with signs of periodontal disease to seek dental care,” Pietropaoli said.

 

“Likewise, dental health professionals should be aware that oral health is indispensable to overall physiological health, including cardiovascular status,”

 

said study lead investigator Davide Pietropaoli, D.D.S., Ph.D., of the University of L’Aquila in Italy.

The target blood pressure range for people with hypertension is less than 130/80 mmHg according to the latest recommendations from the American Heart Association/American College of Cardiology. In the study, patients with severe periodontitis had systolic pressure that was, on average, 3 mmHg higher than those with good oral health. Systolic pressure, the upper number in a blood pressure reading, indicates the pressure of blood against the walls of the arteries. While seemingly small, the 3mmHg difference is similar to the reduction in blood pressure that can be achieved by reducing salt intake by 6 grams per day (equal to a teaspoon of salt, or 2.4 grams of sodium), the researchers said.

The presence of periodontal disease widened the gap even farther, up to 7 mmHg, among people with untreated hypertension, the study found. Blood-pressure medication narrowed the gap, down to 3 mmHg, but did not completely eliminate it, suggesting that periodontal disease may interfere with the effectiveness of blood pressure therapy.

“Patients with high blood pressure and the clinicians who care for them should be aware that good oral health may be just as important in controlling the condition as are several lifestyle interventions known to help control blood pressure, such as a low-salt diet, regular exercise and weight control,” Pietropaoli said.

While the study was not designed to clarify exactly how periodontal disease interferes with blood pressure treatment, the researchers say their results are consistent with previous research that links low-grade oral inflammation with blood vessel damage and cardiovascular risk.

Diabetes causes shift in oral microbiome that fosters periodontitis, Penn study finds.

Doctor Krape Cosmetic & Specialized Dentistry continues to keep you informed as to the new studies, trending techniques and medical advances that can affect or change the way Dentistry is practiced, which can affect the overall health of not just your teeth but your entire body! Diabetes continues to have ill effects on much more than previously understood. Please read!

A new study led by University of Pennsylvania researchers has found that the oral microbiome is affected by diabetes, causing a shift to increase its pathogenicity. The research, published in the journal Cell Host & Microbe, not only showed that the oral microbiome of mice with diabetes shifted but that the change was associated with increased inflammation and bone loss.

“Up until now, there had been no concrete evidence that diabetes affects the oral microbiome,” said Dana Graves, senior author on the new study and vice dean of scholarship and research at Penn’s School of Dental Medicine. “But the studies that had been done were not rigorous.”

Just four years ago, the European Federation of Periodontology and the American Academy of Periodontology issued a report stating there is no compelling evidence that diabetes is directly linked to changes in the oral microbiome. But Graves and colleagues were skeptical and decided to pursue the question, using a mouse model that mimics Type 2 diabetes.

“My argument was that the appropriate studies just hadn’t been done, so I decided, We’ll do the appropriate study,” Graves said.

Graves co-authored the study with Kyle Bittinger of the Children’s Hospital of Philadelphia, who assisted with microbiome analysis, along with E Xiao from Peking University, who was the first author, and co-authors from the University of São Paulo, Sichuan University, the Federal University of Minas Gerais and the University of Capinas. The authors consulted with Daniel Beiting of Penn Vet’s Center for Host-Microbial Interactions and did the bone-loss measurements at the Penn Center for Musculoskeletal Diseases.

Graves co-authored the study with Kyle Bittinger of the Children’s Hospital of Philadelphia, who assisted with microbiome analysis, along with E Xiao from Peking University, who was the first author, and co-authors from the University of São Paulo, Sichuan University, the Federal University of Minas Gerais and the University of Capinas. The authors consulted with Daniel Beiting of Penn Vet’s Center for Host-Microbial Interactions and did the bone-loss measurements at the Penn Center for Musculoskeletal Diseases.

“We were able to induce the rapid bone loss characteristic of the diabetic group into a normal group of animals simply by transferring the oral microbiome,” said Graves.

With the microbiome now implicated in causing the periodontitis, Graves and colleagues wanted to know how. Suspecting that inflammatory cytokines, and specifically IL-17, played a role, the researchers repeated the microbiome transfer experiments, this time injecting the diabetic donors with an anti-IL-17 antibody prior to the transfer. Mice that received microbiomes from the treated diabetic mice had much less severe bone loss compared to mice that received a microbiome transfer from untreated mice.

The findings “demonstrate unequivocally” that diabetes-induced changes in the oral microbiome drive inflammatory changes that enhance bone loss in periodontitis, the authors wrote.

Though IL-17 treatment was effective at reducing bone loss in the mice, it is unlikely to be a reasonable therapeutic strategy in humans due to its key role in immune protection. But Graves noted that the study highlights the importance for people with diabetes of controlling blood sugar and practicing good oral hygiene.

“Diabetes is one of the systemic disease that is most closely linked to periodontal disease, but the risk is substantially ameliorated by good glycemic control,” he said. “And good oral hygiene can take the risk even further down.”

The study was supported by grants from the National Institute of Dental and Craniofacial Research (DE017732 and DE021921) with assistance from Penn Vet’s Center for Host-Microbioal Interactions and the Penn Center for Musculoskeletal Disorders.

Article: Diabetes Enhances IL-17 Expression and Alters the Oral Microbiome to Increase Its Pathogenicity, Dana T. Graves et al., Cell Host & Microbe, doi: 10.1016/j.chom.2017.06.014, published 12 July 2017.